New Medical Practice Credentialing Services
What Is New Practice Credentialing?
New practice credentialing is the complete process of enrolling a newly formed medical practice with insurance payers so it can bill in-network. It covers NPI registration (Type 1 individual and Type 2 group), CAQH ProView setup, Medicare PECOS enrollment (CMS-855I, 855B, and 855R), state Medicaid enrollment, and commercial payer applications — ideally submitted simultaneously. For a practice starting from scratch, the full process takes 90 to 120 days from clean submission to effective date confirmation.
New Medical Practice Credentialing Services From Day 1 Through First Billing
Every new practice needs credentialing before billing insurance. ProEnrollment handles everything: NPI setup, CAQH ProView, Medicare PECOS, Medicaid, and all commercial payers simultaneously. Typical completion in 90 days, so revenue begins on schedule.
The Correct Order of Steps to Launch a New Practice
The right sequence prevents costly delays: (1) Business formation with an LLC or PLLC and EIN; (2) State business and professional license verification; (3) NPI Type 1 and Type 2 registration at NPPES; (4) CAQH ProView profile setup for both individual and group; (5) Simultaneous submission to Medicare PECOS, state Medicaid, and all commercial payers; (6) EHR and billing system configuration; (7) See self-pay patients while credentialing completes; (8) Begin in-network billing after written effective date confirmation.
Why Starting Credentialing Early Matters
The single most common and costly mistake new practices make is waiting until the doors are physically open to start credentialing. By then, 30 to 60 days are already lost. For a physician generating $30,000 per month, every month of delay is $30,000 in unrecoverable revenue. ProEnrollment accepts clients pre-launch and submits applications the day CAQH is complete.
New Practice Credentialing FAQs
How long does credentialing take for a brand new practice?
For a new practice starting from scratch (no prior NPI, no CAQH profile), the full credentialing process takes 90–120 days from clean submission to effective date confirmation across all target payers. The timeline breaks down as: Days 1–10 for NPI registration, entity formation, and CAQH setup; Day 10 for simultaneous application submission to all payers; Days 10–90 for active follow-up and deficiency resolution; Days 90–120 for effective date confirmations. ProEnrollment achieves 40% faster timelines through pre-submission audit and weekly follow-up.
Can a new practice bill any insurance before credentialing is complete?
No. A practice cannot bill insurance in-network before receiving a written effective date from that payer. Services rendered before the effective date are not billable retroactively at most commercial payers or Medicare. However, a new practice CAN accept self-pay patients and collect cash/credit card payments during the credentialing period. Many new practices also negotiate 'single case agreements' (SCAs) with payers to bill specific patients while credentialing is in process. ProEnrollment assists with SCA requests during the credentialing period.
What is the correct order of steps to set up a new medical practice?
The correct sequence: (1) Business formation - LLC/PLLC with EIN from IRS; (2) State business license and professional license verification; (3) NPI Type 1 (individual) + NPI Type 2 (group entity) registration at NPPES; (4) CAQH ProView profile setup (both individual and group); (5) Simultaneous application submission - Medicare PECOS (CMS-855I + 855B + 855R), state Medicaid, and all commercial payers; (6) EHR/billing system setup configured for the practice; (7) Begin seeing self-pay patients while credentialing completes; (8) First in-network billing begins after written effective date.
How much does new practice credentialing cost?
ProEnrollment's managed credentialing service for a new solo practice runs $300–$700/month depending on the number of target payers and states. For a group practice adding multiple providers, pricing is per-provider. Compare this to the alternative: hiring a credentialing specialist at $65,000–$95,000/year (plus benefits), or the revenue loss from the timeline delays that come with inexperienced in-house management. ProEnrollment's 40% faster timelines typically recover the service fee within the first 30–60 days of billing.
What happens if credentialing is denied for a new practice?
Most new practice credentialing denials are actually 'deficiencies' - requests for additional documentation - rather than outright denials based on qualifications. The most common new practice deficiencies are: CAQH-NPPES address mismatch, malpractice coverage gaps, missing work history, and incorrect taxonomy codes. ProEnrollment's pre-submission audit catches and corrects all common deficiencies before submission. Our 99.4% first-time approval rate across all client applications means less than 1% of applications require formal resubmission.
Do I need to credential with both Medicare and Medicaid for a new practice?
You need to credential separately with Medicare (through PECOS) and each state Medicaid program where your patients are located. Medicare credentialing with CMS covers Medicare fee-for-service nationwide. Medicaid is state-by-state - each state has its own portal, requirements, and timeline. If you're in a Medicare Advantage or Medicaid Managed Care state, you also need to credential with the MCOs (Molina, Centene, WellCare, Amerigroup) separately from the state Medicaid base enrollment. ProEnrollment handles all of these simultaneously.
What is the single most common mistake new practices make with credentialing?
The single most common mistake is waiting until the practice is physically open before starting credentialing. By then, 30–60 days have already been lost. For a physician generating $30,000/month, each month of credentialing delay costs $30,000 in unrecoverable revenue. Start credentialing on Day 1 of business formation. A practice that waits 30 days to start credentialing loses 30 days of potential revenue at the end of the credentialing period. For a physician practice generating $30,000/month, that's $30,000 in preventable revenue delay. ProEnrollment begins accepting clients pre-launch and submits applications the day CAQH is complete.